TOA E-Connect October 20, 2008

October 20, 2008

By Timothy L. Beck, MD
President, Texas Orthopaedic Association

Keep your eye out for the fall TOA Orthopaedic Connection newsletter. You will be receiving it next week in the mail. Some of the featured articles include information on the 2009 Annual Meeting and Socioeconomic Summit, legislative update by Mignon McGarry and information on Maintenance of Certification (MOC) and deadlines. Part

Maintenance of Certification: Need CME Hours?

A good source of free online continuing medical education can be found at Medscape. A couple of CME activities available from Medscape at this time are:

You can click here to gain access to the Medscape site. Another free interactive accredited site is Emedicine from WebMD which can be reached by clicking here. Of course, AAOS's Orthopaedic Knowledge Online site, while not free, is the premiere CME site.

By Michael Reed, MPA, MBA, Director of Healthcare Delivery Systems
Texas Medical Association

State insurance regulators fined Blue Cross and Blue Shield of Texas (BCBSTX) $250,000 and ordered the insurance giant to repay $3.9

million to members for underpaying claims related to treatment in out-of-network hospitals and other medical facilities. Blue Cross denied the allegations but agreed not to contest the Texas Department of Insurance (TDI) findings of fact, a TDI consent order said.

The restitution must be paid over the next several months, said State Insurance Commissioner Mike Geeslin, adding that if the payments do not total at least $3.9 million, BCBSTX must pay the balance to the state as an additional fine.

Blue Cross must notify affected members of the reimbursements by mid-December. In addition, Blue Cross officials have to implement new procedures for paying claims at out-of-network facilities by the middle of August.

"TDI has received complaints that BCBSTX has set its 'allowable' amounts for uncontracted facilities at unreasonable low rates that are less than the amounts billed by the facilities and also less than the rates paid to BCBSTX contracted facilities," the TDI order said. "TDI has alleged that BCBSTX's reimbursement rates are unreasonably low in light of representations made by the company in its advertising and its policies and that the reimbursement rates are so low as to violate Texas insurance laws and regulations."

TDI Deputy Commissioner for Regulatory Affairs Doug Danzier told the Dallas Morning News that the underpayments dated to Jan. 1, 2004, and involved thousands of Blue Cross members in Texas enrolled in PPO plans. He said most of the affected consumers sought care in out-of-network hospitals because of medical emergencies or the services they required were not available in regular network facilities.

Blue Cross did not respond to a request for a comment on the TDI action.
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The Texas Orthopaedic PAC needs your help again. With the 2008 General Election fast approaching, we need your help to assist our friends in the Texas Legislature.

TOPAC recently hosted a very successful event for Rep. Helen Giddings, Chair of House Business and Industry. Chair Giddings was instrumental last Session with 3 pieces of legislation improving Workers Compensation in Texas.

Providing help to our friends is the reason that we continue to have friends.

The Texas Legislature convenes in January. What Will They Be Talking About??? Tort Reform, Corporate Practice of Medicine, Independent Practice for Nurses, Workers Compensation and Scope of Practice among others.

Your TOPAC Participation Ensures that Your Voice is Heard in Austin!

Dr. Charles Mitchell, Dr. Maureen Finnegan and Representative Helen Giddings